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									                                       El Paso Police Department
                            Comprehensive Background Investigation Statement

APPLICANT NAME (LAST, FIRST, MIDDLE)                                                    TODAY’S DATE




                                                    INSTRUCTIONS
1.   The information in this questionnaire will be used for the Comprehensive Background examination component.
     Examination protest procedures are covered under Rule 9 Sec. 7 (C) of the Civil Service Commission (CSC) Rules and
     Regulations as follows:

     For all other types of examinations as specified in CSC Rule 10, Section 2 (b-f), applicants may file a written protest
     immediately following the administration of the examination. No protests will be accepted after the date on which the
     administration of the examination is completed. Such protests must contain specific points or objections to specific
     questions, action or procedures. Applicants filing protests will be notified of the disposition of their protests and if
     dissatisfied, can appeal to the Civil Service Commission within five days of notice in a manner consistent with the Rules
     and Regulations.
.
2.   It is your responsibility to provide all the requested information clearly and completely. Be advised, if necessary,
     we may request additional documentation and/or details. A candidate that fails to properly complete this questionnaire as
     instructed, will no longer be considered for this position.

3.   Comprehensive Background Statements returned illegible, incomplete, or received after the deadline will not be evaluated
     and the applicant will no longer be considered for this position.

4.   If you have any questions, contact the EPPD Human Resources Division at (915) 564-6958.

     Please read the statement below and sign it after completing the supplementary questionnaire.

          I certify that my statements in this questionnaire are true, complete and correct to the best of my knowledge and
          belief. I understand that any falsification and/or omission of information may bar me from the examination, remove
          my name from the eligible list or if I have been appointed, cause my dismissal from the position. I also agree that all
          statements may be investigated.

     Print name

     Signature__________________________________________                            Date___________________________



THIS IS NOT AN OFFER, CONTRACT OR CONDITION OF EMPLOYMENT BY THE CITY OF EL PASO. ACTUAL
CONDITIONS OF EMPLOYMENT ARE GOVERNED BY CITY CIVIL SERVICE PROVISIONS AND THE COLLECTIVE
BARGAINING AGREEMENT BETWEEN THE CITY AND THE EL PASO MUNICIPAL POLICE OFFICERS
ASSOCIATION AND ARE SUBJECT TO CHANGE. NOTHING CONTAINED HEREIN CONSTITUTES AN OFFER,
CONTRACT, OR CONDITION OF EMPLOYMENT BY THE CITY OF EL PASO.


                                       El Paso Police Department ♦ Human Resources Division
                                                 911 N. Raynor ♦ El Paso, TX 79903
                                                    915-564-6958 ♦ www.eppd.org



                                                           Page 1 of 19
                                                      INSTRUCTIONS

                                             Required Documents
When you submit your Comprehensive Background Investigation Statement (CBIS), unless otherwise indicated, please
provide a copy of each of the documents listed below. If you are missing any of the following documents, you are still
expected to submit your background statement by the deadline and make immediate arrangements to obtain the missing
documents.
        a. County Birth Certificate
        b. Naturalization Papers if applicable
        c. Driver’s License
        d. Social Security Card
        e. Current proof of vehicle liability insurance
        f. High School Diploma or GED Certificate
        g. Official College Transcripts (copies not accepted; original only)
        h. Criminal/Civil Case Dispositions
        i. All DD-214 forms (member-4) that you have received in your lifetime. (Military Personnel)


                                           PLEASE READ CAREFULLY
Unless otherwise stated, each question refers to anytime, anyplace, anywhere, for any reason, both in civilian life or
military life, domestic or abroad. It does NOT matter if the incident or act was detected, undetected, reported or
unreported, investigated or not, discovered or if anyone was arrested or not.

Your Comprehensive Background Investigation Statement (CBIS) is subject to a complete background investigation consisting of
personal, family, education, traffic, criminal, neighborhood, employment and financial history. Questions relating to age, height,
weight, and any other physical characteristics, when not specifically related to the job requirements, are used for the purpose of
identification in your background investigation and for no other purpose.

These instructions are provided as a guide to assist you in properly completing the CBIS. It is essential that ALL information be
entirely accurate in all respects. Deliberate inaccuracies, incomplete statements, rationalizations, misstatements of fact, or
omission of material information reported in this CBIS, or divulged by you during the background investigation may be
grounds for your disqualification and/or termination of your employment with the El Paso Police Department.

It is to your advantage to respond openly and honestly to all of the questions. Any negative factors in your background will be
evaluated in terms of circumstances and facts surrounding the occurrence and its degree of relevance to the job. The El Paso Police
Department is looking for mature, honest people who can admit to their mistakes and discuss those mistakes honestly. For example,
being fired from a job or having been arrested is not, in itself, necessarily grounds for disqualification. You will be given a chance
during your background investigation to explain the facts surrounding the events. It is your responsibility to be truthful. A negative
factor in your background may not terminate you from the application process; being dishonest about a negative factor will. BE
HONEST. All the information will be verified by an extensive background investigation.

REMEMBER: the ability to create or write neat, legible, accurate and complete reports as well as the ability to follow
instructions is an important part of police work.




                                                             Page 2 of 19
                                               INSTRUCTIONS
                                                 INSTRUCTIONS


1.      PRINT or TYPE, all answers in BLACK ink. DO NOT LEAVE ANY QUESTION BLANK. This statement
must be filled out and completed by YOU and no one else. Be sure that you fill out this Comprehensive Background
Investigation Statement (CBIS) correctly and completely, because you are the one that is swearing, under oath, to the
Notary Public, that all the information contained herein is true and correct. Your CBIS must be filled out NEATLY,
COMPLETELY and CORRECTLY.

2.      Answer EVERY question to the best of your ability. Explain incomplete answers. If the question does not apply
to you, indicate N/A. YOU ARE RESPONSIBLE for obtaining all correct and complete names, addresses, phone
numbers, zip codes and area codes where requested. If you are not sure of your information, verify it PERSONALLY
before submitting your CBIS. When indicating dates, do not use the military method; indicate the month, day and then
year.

3.     You must include two (2) recent pictures of yourself when returning this statement. Attach one picture to the
bottom of page 4. The other picture will be utilized for your Background Investigation. The pictures MUST be least 2”
x 2” and NO LARGER than 3” x 4”. The pictures must show your head and shoulders, with a PLAIN light colored
background. NO computer generated, scenic or group pictures will be accepted. A Polaroid or Passport picture is
acceptable. The picture must have been taken within three (3) months of the date the statement is submitted.

4.      If more space is needed to answer any question, use Section XVII Miscellaneous Info. When using Section XVII,
be sure to indicate which question you are expanding on.

5.      Once you have completed everything and obtain all necessary documents/copies, you MUST have the last three
(3) pages notarized before you can submit your CBIS.

6.      If you have any problems while completing the CBIS or you are unsure what information you should list, do not
hesitate to call and ask for assistance. The EPPD Human Resources Division phone number is 564-6958 and the work
hours are Monday through Friday, 8:00 A.M. to 4:00 P.M.

I understand that AFTER I have submitted this Comprehensive Background Investigation Statement, I MUST
inform the Background Investigators, IMMEDIATELY, of any changes or updated information contained in this
statement. All changes or updated information MUST be made both orally and in writing within seven (7) days
of the date of any change. Failure to do so could be basis for Rejection of my employment with the El Paso Police
Department. All information obtained during the investigation will be used as a basis of questioning during the
Chief Selection Board.



I have read the above instructions and understand and will comply with all the instructions herein.


       PRINT NAME                                                         SIGNATURE

                                            DATE




                                                     Page 3 of 19
ATTACH 2" x 2", BUT NO LARGER THAN 3” x 4” PHOTO BELOW




             Attach a photo of yourself
                       HERE
          prior to turning in this statement




                       Page 4 of 19
                                                  I. PERSONAL INFORMATION
FULL LEGAL NAME (LAST, FIRST, MIDDLE)                                                                                 SOCIAL SECURITY NUMBER

LIST ALL OTHER NAMES OR NICKNAMES USED (INCLUDE ANY MAIDEN NAMES AND LEGAL NAME CHANGES. LIST DATE AND
REASON FOR NAME CHANGE)

DRIVERS LICENSE #                     STATE          EXP. DATE             BIRTHDATE                BIRTHPLACE (CITY, STATE, COUNTRY)

RESIDENCE ADDRESSESS (STREET, CITY, STATE, ZIP CODE)

HOME PHONE NUMBER                            CELL PHONE NUMBER                   FAX NUMBER                   E-MAIL ADDRESS

WORK PHONE NUMBER                            ALTERNATE PHONE NUMBER FOR MESSAGES                              PAGER NUMBER


ARE YOU A CITIZEN OF THE UNITED STATES?
                                                                                 IF A U.S. CITIZEN, WERE YOU:        NATIVE BORN
YES     NO
                                                                                                                     NATURALIZED
IF NATURALIZED, GIVE DATE, LOCATION, AND NATURALIZATION NUMBER


HAVE YOU EVER APPLIED TO THE EL PASO POLICE DEPARTMENT                   IF SO, WHEN AND DISPOSITION
BEFORE?
YES     NO

                                               II.            EMPLOYMENT HISTORY
IMPORTANT NOTICE: You must list every job you have ever held, regardless of whether you feel it is relevant to the position for which you are
applying. Failure to complete all required information (names, addresses, dates, phone numbers) may limit our ability to assess your suitability for hire,
and eliminate you from further consideration.

BEGIN WITH YOUR CURRENT EMPLOYMENT AND WORK BACKWARDS. LIST ALL EMPLOYMENT CHRONOLOGICALLY, INCLUDING SUMMER AND
PART TIME JOBS, TEMPORARY AND VOLUNTEER WORK. COMPLETE INFORMATION IS REQUIRED.

     DATES EMPLOYED:                               EMPLOYER INFORMATION:                          PHONE AND EXT. NUMBER:
        FROM:                       TO:           NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)  EMPLOYER TELEPHONE:

# OF HOURS WORKED/WEEK & SHIFT                    SUPERVISOR’S NAME/TITLE:                          REASON FOR LEAVING:
WORKED:                                                                                                          FIRED                  SCHOOL
                                                                                                                 LAID OFF                QUIT
                                                                                                                 FORCED                  OTHER
SALARY WAGE:                                      JOB TITLE & DUTIES:

     DATES EMPLOYED:                               EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
        FROM:                       TO:           NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:


# OF HOURS WORKED/WEEK & SHIFT                    SUPERVISOR’S NAME:                                REASON FOR LEAVING:
WORKED:                                                                                                          FIRED                  SCHOOL
                                                                                                                 LAID OFF                QUIT
                                                                                                                 FORCED                  OTHER
SALARY WAGE:                                      JOB TITLE & DUTIES:

     DATES EMPLOYED:                               EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
        FROM:                       TO:           NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:


# OF HOURS WORKED/WEEK & SHIFT                    SUPERVISOR’S NAME:                                REASON FOR LEAVING:
WORKED:                                                                                                          FIRED                  SCHOOL
                                                                                                                 LAID OFF                QUIT
                                                                                                                 FORCED                  OTHER
SALARY WAGE:                                      JOB TITLE & DUTIES
                                                       :


     DATES EMPLOYED:                               EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
        FROM:                       TO:           NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:




                                                                        Page 5 of 19
# OF HOURS WORKED/WEEK & SHIFT            SUPERVISOR’S NAME:                            REASON FOR LEAVING:
WORKED:                                                                                              FIRED           SCHOOL
                                                                                                     LAID OFF         QUIT
                                                                                                     FORCED           OTHER
SALARY WAGE:                              JOB TITLE & DUTIES:

    DATES EMPLOYED:                        EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
       FROM:                 TO:          NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:


# OF HOURS WORKED/WEEK & SHIFT            SUPERVISOR’S NAME:                            REASON FOR LEAVING:
WORKED:                                                                                              FIRED           SCHOOL
                                                                                                     LAID OFF         QUIT
                                                                                                     FORCED           OTHER
SALARY WAGE:                              JOB TITLE & DUTIES:

    DATES EMPLOYED:                        EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
       FROM:                 TO:          NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:

# OF HOURS WORKED/WEEK & SHIFT            SUPERVISOR’S NAME:                            REASON FOR LEAVING:
WORKED:                                                                                              FIRED           SCHOOL
                                                                                                     LAID OFF         QUIT
                                                                                                     FORCED           OTHER
SALARY WAGE:                              JOB TITLE & DUTIES:

    DATES EMPLOYED:                        EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
       FROM:                 TO:          NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:


# OF HOURS WORKED/WEEK & SHIFT            SUPERVISOR’S NAME:                            REASON FOR LEAVING:
WORKED:                                                                                              FIRED           SCHOOL
                                                                                                     LAID OFF         QUIT
                                                                                                     FORCED           OTHER
SALARY WAGE:                              JOB TITLE & DUTIES:

    DATES EMPLOYED:                        EMPLOYER INFORMATION:                           PHONE AND EXT. NUMBER:
       FROM:                 TO:          NAME & ADDRESS OF EMPLOYER (STREET, CITY, STATE, ZIP)   EMPLOYER TELEPHONE:

# OF HOURS WORKED/WEEK & SHIFT            SUPERVISOR’S NAME:                            REASON FOR LEAVING:
WORKED:                                                                                              FIRED           SCHOOL
                                                                                                     LAID OFF         QUIT
                                                                                                     FORCED           OTHER
SALARY WAGE:                              JOB TITLE & DUTIES:



IF YOU HAVE HELD ADDITIONAL JOBS LIST THEM HERE:

IF YOU HAVE YOU EVER BEEN DISCIPLINED, DISMISSED OR ASKED TO RESIGN FROM ANY JOB, EXPLAIN THE CIRCUMSTANCES (INCLUDE DATE,
PLACE & SPECIFIC DETAILS)



HAVE YOU PREVIOUSLY APPLIED TO THE CITY OF EL PASO?     NO      YES      IF YES, WHICH DEPARTMENT(S):

DO YOU HAVE ANY RELATIVES WORKING FOR THE CITY OF EL PASO? NO            YES
IF YES: GIVE NAME, RELATIONSHIP, AND DEPARTMENT THEY WORK FOR:

HAVE YOU EVER WORKED FOR THE CITY OF EL PASO?      NO     YES
IF YES, LIST WHICH DEPARTMENT AND WHEN:
LIST SUPERVISOR’S NAME AND PHONE NUMBER:


ARE YOU NOW, OR HAVE YOU EVER BEEN ENGAGED IN BUSINESS AS AN OWNER, PARTNER OR CORPORATE MEMBER?                NO    YES


MAY WE COMMUNICATE WITH YOUR PRESENT EMPLOYER?          YES       NO         IF NO, PLEASE EXPLAIN:

HAVE YOU EVER APPLIED TO ANY LAW ENFORCEMENT AGENCY OR PUBLIC SAFETY AGENCY (e.g., POLICE DEPARTMENT, SHERIFF’S DEPARTMENT,
FIRE DEPARTMENT, EMT)?
    NO     YES
IF YES, LIST PAST AND PRESENT APPLICATIONS, INCLUDING THOSE WITH THE EL PASO POLICE DEPARTMENT
 AGENCY            ADDRESS           DATE OF APPLICATION         DISPOSITION              BACKGROUND INVESTIGATOR (if known)


                                                              Page 6 of 19
HAVE YOU EVER BEEN INVOLVED IN THE EL PASO POLICE EXPLORER OR VOLUNTEER PROGRAMS?         NO   YES      IF YES, LIST DATES:

HAVE YOU EVER BEEN DENIED A POSITION WITH THE EL PASO POLICE DEPARTMENT?     NO     YES
IF YES, LIST DATES AND REASON:
HAVE YOU EVER BEEN INVOLVED IN ANY OTHER POLICE RESERVE OR AUXILLIARY UNIT? NO   YES
IF YES, INDICATE BELOW:
 AGENCY                 ADDRESS           DATE OF SERVICE           POSITION HELD              REASON FOR LEAVING




HAVE YOU EVER ATTENDED A LAW ENFORCEMENT ACADEMY OR BEEN CERTIFIED OR LICENSED AS A LAW
ENFORCEMENT OFFICER?    NO     YES   IF YES, LIST WHEN AND WHERE:
HAVE YOU EVER BEEN SUBJECTED TO A POLYGRAPH TEST?       NO     YES
IF YES, LIST DETAILS (WHEN, WHERE AND WHY):

                                          III. EDUCATION HISTORY
ARE YOU CURRENTLY ENROLLED IN ANY SCHOOL, COLLEGE OR UNIVERSITY?        NO   YES
IF YES, GIVE PROJECTED GRADUATION DATE:

LIST ALL SCHOOLS EVER ATTENDED IN ORDER. BEGIN WITH THE MOST RECENTLY ATTENDED/CURRENTLY ENROLLED SCHOOL. INCLUDE
BUSINESS COLLEGES, TECHNICAL/VOCATIONAL, CORRESPONDENCE, AND MILITARY SCHOOLS.
                                                COLLEGES AND UNIVERSITIES
                                                  SCHOOL INFORMATION
SCHOOL NAME:                                   ADDRESS (STREET, CITY, STATE, ZIP)               FROM:          TO:


YEAR GRADUATED:            TYPE OF DEGREE OBTAINED:             HOURS EARNED:       GPA:             COMMENTS:


                                                  SCHOOL INFORMATION
SCHOOL NAME:                                   ADDRESS (STREET, CITY, STATE, ZIP)               FROM:          TO:


YEAR GRADUATED:            TYPE OF DEGREE OBTAINED:             HOURS EARNED:       GPA:             COMMENTS:


                                                  SCHOOL INFORMATION
SCHOOL NAME:                                   ADDRESS (STREET, CITY, STATE, ZIP)               FROM:          TO:



YEAR GRADUATED:            TYPE OF DEGREE OBTAINED:             HOURS EARNED:       GPA:             COMMENTS:


                                                  SCHOOL INFORMATION
SCHOOL NAME:                                   ADDRESS (STREET, CITY, STATE, ZIP)               FROM:          TO:


YEAR GRADUATED:            TYPE OF DEGREE OBTAINED:             HOURS EARNED:       GPA:             COMMENTS:


                                                  SCHOOL INFORMATION
SCHOOL NAME:                                   ADDRESS (STREET, CITY, STATE, ZIP)               FROM:          TO:


YEAR GRADUATED:            TYPE OF DEGREE OBTAINED:             HOURS EARNED:       GPA:             COMMENTS:



                          VOCATIONAL / TECHNICAL / MILITARY OR OTHER POST-SECONDARY SCHOOLS


                                                         Page 7 of 19
                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:             TYPE OF DEGREE OBTAINED:                HOURS EARNED:     GPA:         COMMENTS:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:             TYPE OF DEGREE OBTAINED:                HOURS EARNED:     GPA:         COMMENTS:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:             TYPE OF DEGREE OBTAINED:                HOURS EARNED:     GPA:         COMMENTS:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:             TYPE OF DEGREE OBTAINED:                HOURS EARNED:     GPA:         COMMENTS:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:             TYPE OF DEGREE OBTAINED:                HOURS EARNED:     GPA:         COMMENTS:


                                                        HIGH SCHOOL
                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:


YEAR GRADUATED:


                                                    SCHOOL INFORMATION
SCHOOL NAME:                                     ADDRESS (STREET, CITY, STATE, ZIP)            FROM:         TO:



YEAR GRADUATED:



WAS ANY DISCIPLINARY ACTION TAKEN AGAINST YOU WHILE YOU WERE IN COLLEGE OR HIGH SCHOOL, INCLUDING PROBATION, SUSPENSIONS,
DISMISSALS OR LOSS OF SCHOLARSHIPS FOR DISCIPLINARY REASONS?
  NO     YES      IF YES, LIST THE DATES AND DETAILS BELOW:

GIVE EXPLANATION FOR ACADEMIC PROBLEMS, INCLUDING ACADEMIC PROBATIONS, ACADEMIC SUSPENSIONS, WITHDRAWALS (PASSING OR
FAILING), AND ANY GRADE BELOW A 2.00 GPA:

LIST ALL HONORS, CITATIONS, SPECIAL RECOGNITION, OFFICES HELD, AND GROUPS OR TEAMS YOU BELONGED TO WHILE ATTENDING HIGH
SCHOOL AND COLLEGE:


                                                              Page 8 of 19
                                                      IV. MILITARY HISTORY
HAVE YOU EVER BEEN DENIED ENTRY INTO THE MILITARY? NO                    YES       IF YES, EXPLAIN:

HAVE YOU EVER SERVED IN A MILITARY ORGANIZATION OF ANY FOREIGN GOVERNMENT? NO                           YES         IF YES, EXPLAIN:


HAVE YOU EVER JOINED THE MILITARY SERVICE? NO                 YES     IF YES, LIST MILITARY BRANCH AND UNITS SERVED
      BRANCH                   SERVICE NUMBER                  TYPE OF UNIT          M.O.S.      JOB TITLE AND DESCRIPTION

1.

2.
         DATE OF ENLISTMENT                            DATES OF ACTIVE DUTY                        HIGHEST RANK ON ACTIVE DUTY




TYPE OF DISCHARGE OR SEPARATION:              HONORABLE                    GENERAL-UNDER HONORABLE
                                              DISHONORABLE                 GENERAL-UNDER OTHER THAN HONORABLE
                                      BAD CONDUCT
GIVE A BRIEF EXPLANATION OF REASONS FOR DISCHARGE:
INDICATE STATUS AT TIME OF DISCHARGE BELOW:
    DATE OF DISCHARGE              RANK AT TIME OF DISCHARGE                DATE OF RANK            TOTAL AMOUNT OF MILITARY SERVICE
                                                                                                   YEARS            MONTHS       DAYS


LIST ALL CITATIONS OR COMMENDATIONS:


LIST ALL MILITARY TRAINING AND EDUCATION:


HAVE YOU EVER BEEN UNDER INVESTIGATION BY A MILITARY AUTHORITY? NO             YES
IF YES: LIST ALL DISCIPLINARY PROBLEMS WHILE IN THE MILITARY (ARTICLE 15’s, UCMJ CONVICTIONS, DEMOTIONS, INCLUDING ANY JUDICIAL
OR NON-JUDICIAL ACTION ETC.) INCLUDE DISPOSITION OF INVESTIGATION AND EXPLAIN IN FULL DETAIL:

PAST COMMANDING OFFICERS OR MILITARY ACQUAINTANCES ARE POTENTIAL SOURCES OF RELEVANT INFORMATION PERTAINING TO YOUR
BACKGROUND. PLEASE LIST THOSE INDIVIDUALS WHO KNOW YOU WELL ENOUGH TO PROVIDE ACCURATE INFORMATION ABOUT YOU.
NAME                                            ADDRESS                                          PHONE                        # OF YEARS KNOWN
1
2
3

HAVE YOU EVER BEEN A MEMBER OF A RESERVE UNIT?             NO        YES       IF YES, INDICATE YOUR STATUS BELOW
CURRENTLY ACTIVE RESERVE? NO                YES                                MEMBER IN I.R.R.? NO           YES
HOW OFTEN DO YOU ATTEND DRILLS?          WEEKLY                  MONTHLY                      SUMMER ONLY
GIVE DETAILS OF YOUR CURRENT RESERVE UNIT BELOW:
UNIT NAME AND ADDRESS                                              COMMANDING OFFICER NAME &PHONE                            YOUR CURRENT RANK



                                        V. CRIMINAL AND DRIVING HISTORY
LIST ALL OFFICIAL CONTACT YOU HAVE HAD WITH ANY LAW ENFORCEMENT AGENCY OR COURT SYSTEM. THIS INCLUDES MUNICIPAL, COUNTY, STATE
AND FEDERAL AGENCIES OR COURT SYSTEMS, INCLUDING MILITARY COURTS, MILITARY POLICE AND MILITARY INVESTIGATIVE UNITS. LIST ALL
INCIDENTS WHERE YOU HAVE BEEN QUESTIONED, WARNED, ISSUED A CITATION (CLASS C OR TRAFFIC), DETAINED, ARRESTED OR CONVICTED. THIS
INCLUDES ALL INFRACTIONS, ORDINANCE VIOLATIONS, MISDEMEANORS AND FELONIES. It is to your benefit to be honest.
NOTE: All applicants with a prior criminal history (class B misdemeanor or above) must provide documentation indicating the final disposition of any and
all arrest.
      DATE                  AGENCY OR COURT                   CITY/STATE                          CHARGE               DISPOSITION




                                                                      Page 9 of 19
HAVE YOU EVER BEEN IN OR AFFILIATED WITH ANY STREET GANG?        NO      YES     IF YES, EXPLAIN IN FULL DETAIL:

HAVE YOU EVER STOLEN OR TAKEN ANYTHING FROM ANYONE WITHOUT PERMISSION, OR COMMITTED ANY OTHER CRIME IN WHICH YOU WERE
NOT CAUGHT? NO       YES     IF YES, EXPLAIN IN FULL DETAIL, INCLUDING DATES, PLACES AND AMOUNT TAKEN OR CRIME COMMITTED :


HAVE YOU EVER APPLIED FOR A PERMIT TO CARRY A CONCEALED WEAPON?           NO    YES      IF YES, WAS THE REQUEST GRANTED?
NO       YES     IF NO PLEASE EXPLAIN:

HAS AN EX-PARTE OR OTHER TYPE OF RESTRAINING ORDER OR PROTECTIVE ORDER EVER BEEN PLACED AGAINST YOU?               NO   YES
IF YES, EXPLAIN:

LIST BELOW ANY FRIENDS, ASSOCIATES OR RELATIVES, PAST AND PRESENT WHO HAVE BEEN ARRESTED OR CONVICTED OF A FELONY OR
PARTICIPATED IN A CRIMINAL ACT. GIVE A BRIEF EXPLANATION OF YOUR RELATIONSHIP TO THE PERSON AND THE CRIMINAL ACTIVITY IN
WHICH THEY ARE OR WERE INVOLVED:
    NAME (LAST,FIRST MIDDLE)                  RELATIONSHIP             EXPLAIN CRIMINAL ACTIVITES AND/OR CONVICTIONS




DO YOU CURRENTLY HAVE ANY UNPAID FINES, COURT COSTS, OR COURT ORDERED RESTITUTION?    NO                 YES
IF YES, GIVE ALL DETAILS, INCLUDING THE LAW ENFORCEMENT AGENCY, LOCATION AND COURT DATES:
HAVE YOU EVER BEEN FINGERPRINTED?      NO       YES     IF YES, BY WHOM AND WHY?


GIVE INFORMATION ON ANY DRIVER’S LICENSE OR PERMIT THAT YOU HAVE BEEN ISSUED CURRENTLY OR IN THE PAST (INCLUDING MILITARY
AND ANY SPECIAL ENDORSEMENTS):
APPROX. DATE ISSUED            STATE        LICENSE NUMBER       TYPE (OPERATOR, COMMERCIAL, MILTARY, ETC.)    EXPIRATION DATE




HAVE YOU EVER BEEN INVOLVED AS A DRIVER IN A MOTOR VEHICLE COLLISION?
NO     YES     IF YES, LIST EACH COLLISION BELOW STARTING WITH THE MOST RECENT:
1                                                COLLISION INFORMATION
DATE OCCURRED:                         LOCATION (CITY, STATE):         INVESTIGATING AGENCY:        INJURY INVOLVED?
                                                                                                    NO      YES
AMOUNT OF DAMAGE?                                 WHO WAS AT FAULT?                       HOW DID COLLISION OCCUR?


2                                              COLLISION INFORMATION
DATE OCCURRED:                         LOCATION (CITY, STATE):     INVESTIGATING AGENCY:           INJURY INVOLVED?
                                                                                                   NO      YES
AMOUNT OF DAMAGE?                                 WHO WAS AT FAULT?                       HOW DID COLLISION OCCUR?

3                                              COLLISION INFORMATION
DATE OCCURRED:                         LOCATION (CITY, STATE):    INVESTIGATING AGENCY:            INJURY INVOLVED?
                                                                                                   NO      YES
AMOUNT OF DAMAGE?                                 WHO WAS AT FAULT?                       HOW DID COLLISION OCCUR?

4                                              COLLISION INFORMATION
DATE OCCURRED:                         LOCATION (CITY, STATE):     INVESTIGATING AGENCY:           INJURY INVOLVED?
                                                                                                   NO      YES
AMOUNT OF DAMAGE?                                 WHO WAS AT FAULT?                       HOW DID COLLISION OCCUR?


HAS YOUR LICENSE EVER BEEN SUSPENDED OR REVOKED?        NO       YES     IF YES, PLEASE GIVE DETAILS (INCLUDE WHEN, WHERE):




                                                             Page 10 of 19
HAVE YOU EVER BEEN DENIED AUTO INSURANCE OR HAD INSURANCE CANCELLED? NO                             YES      IF YES, EXPLAIN BELOW:


PLEASE LIST ALL OF YOUR CURRENT VEHICLES BELOW: (MUST PROVIDE COPIES OF ALL VEHICLE INSURANCE POLICIES)
     YEAR:            MAKE:                          MODEL:                         PLATE NUMBER:         STATE:   REGISTERED TO:




                                                                VI. DRUG USAGE
DO YOU CURRENTLY USE ANY DRUG THAT YOU HAVE OBTAINED WITHOUT A PRESCRIPTION OR HAVE OBTAINED BY SOME OTHER MEANS?                     NO
    YES     IF YES, LIST WHAT KIND AND TO WHAT EXTENT:

DO YOU HAVE ANY CLOSE FRIENDS THAT YOU KNOW USE ILLEGAL DRUGS OR SIMILAR SUBSTANCES?
NO     YES     IF YES, TELL US HOW MANY OF YOUR FRIEND(S) AND WHAT TYPE OF DRUGS YOUR FRIEND(S) USE OR USED:
DO YOU NOW, OR HAVE YOU EVER USED, POSSESSED, SUPPLIED, SOLD OR MANUFACTURED ANY NARCOTIC OR CONTROLLED SUBSTANCE SUCH
AS, BUT NOT LIMITED TO; MARIJUANA, HASHISH, COCAINE, BARBITURATES (DOWNERS), PSP, LSD, MORPHINE, MUSHROOMS, QUAALUDES,
EXTASY, METHAMPHETAMINE, HEROIN, STEROID PHARMACEUTICALS, DESIGNER DRUGS OR DRUGS OF SIMILAR NATURE ? (Drug use is not
necessarily an automatic disqualifying factor, however, lying about it is.)
NO        YES        IF YES, LIST BELOW AND PROVIDE DETAILS.

 SUBSTANCE:                        EVER USED?       FIRST DATE USED LAST DATE USED NUMBER OF TIMES USED LARGEST AMT. POSSESSED

MARIJUANA                        NO      YES

HASHISH                          NO      YES
COCAINE/CRACK                    NO      YES

PCP (Angel Dust)                 NO      YES
HEROIN                           NO      YES
LSD                              NO      YES
METHAMPHETAMINES
(UPPERS, SPEED)
                                 NO      YES

OTHER (LIST)

OTHER (LIST)

OTHER (LIST)


GIVE A DETAILED SUMMARY CONCERNING THE CIRCUMSTANCES OF ANY OF THE DRUG HISTORY INDICATED ABOVE

DO YOU CURRENTLY CONSUME ALCOHOLIC BEVERAGES?                    NO           YES
IF YES, PLEASE EXPLAIN BY INCLUDING FREQUENCY, QUANTITY AND TYPE OF BEVERAGE (E.G., LIQUOR, WINE, BEER):


HAVE YOU EVER DRIVEN UNDER THE INFLUENCE OF DRUGS OR ALCOHOL?                        NO    YES
IF YES, EXPLAIN THE CIRCUMSTANCES AND NUMBER OF TIMES

                                  VII. ORGANIZATIONS AND OTHER ACTIVITIES
LIST ANY HOBBIES, SKILLS AND SPECIAL INTERESTS OR ABILITIES YOU HAVE, INCLUDING ANY HONORS YOU HAVE RECEIVED WHILE INVOLVED
IN THESE ACTIVITIES:

LIST ANY SPECIALIZED TRAINING, SKILLS OR AREAS OF EXPERTISE THAT YOU HAVE WHICH ARE DIRECTLY OR INDIRECTLY RELATED TO LAW
ENFORCEMENT WORK:

LIST ANY OTHER INFORMATION ABOUT YOURSELF THAT IS NOT ASKED BY THE ABOVE QUESTIONS WHICH YOU FEEL WOULD BE BENEFICIAL FOR
US TO KNOW :

                                         VIII. CREDIT AND FINANCIAL HISTORY
LIST AND EXPLAIN ALL FINANCIAL PROBLEMS, PAST OR PRESENT. INCLUDE OVERDUE ACCOUNTS, LATE PAYMENTS, BANKRUPTCIES, FAILURE TO
PAY STUDENT LOANS, ETC. (A COMPLETE CREDIT HISTORY WILL BE OBTAINED BY THE EL PASO POLICE DEPARTMENT):




                                                                         Page 11 of 19
LIST YOUR NET MONTHLY INCOME, SPOUSE’S NET MONTHLY INCOME, TOTAL MONTHLY PAYMENTS (INCLUDE MORTGAGE/RENT, UTILITIES,
CREDITORS, AUTO LOANS, ETC.), AND TOTAL INDEBTEDNESS (TOTAL BALANCE OF ALL FINANCIAL OBLIGATIONS):

HAVE YOU EVER HAD PURCHASED GOODS REPOSSESSED OR HAD ANY OF YOUR BILLS TURNED OVER TO A COLLECTION AGENCY?               NO     YES
   IF YES, PLEASE EXPLAIN:

HAVE YOUR OR WAGES EVER BEEN GARNISHED?    NO      YES          IF YES, PLEASE EXPLAIN:

HAVE YOU EVER BEEN, OR ARE YOU NOW DELINQUENT ON TAXES TO ANY CITY, COUNTY, STATE OR FEDERAL GOVERNMENT?            NO        YES
IF YES, PLEASE EXPLAIN:
HAVE YOU OR YOUR SPOUSE EVER WRITTEN ANY BAD OR INSUFFICIENT FUND CHECKS? NO         YES
IF YES, PLEASE LIST AND EXPLAIN (INCLUDE ESTIMATED NUMBER OF BAD CHECKS AND DATE OF LAST BAD CHECK WRITTEN):
WAS PROPERTY REPOSSESSED AS A RESULT? NO         YES    IF YES, PLEASE EXPLAIN:
TO WHOM WERE THE BAD CHECKS WRITTEN?

HAVE ANY OF YOUR CHECKS EVER BEEN TURNED OVER TO THE DISTRICT ATTORNEY FOR PROSECUTION?
NO     YES     IF YES, PLEASE EXPLAIN WHAT THE OUTCOME WAS:

HAVE YOU EVER HAD A JUDGMENT RENDERED AGAINST YOU?         NO       YES       IF YES, PROVIDE AMOUNT AND DETAILS:


                                 IX. FAMILY INFORMATION ~ MARITAL
CURRENT MARITAL STATUS: MARRIED          WIDOWED       DIVORCED           ENGAGED        SEPARATED
                        UNMARRIED         ANNULLED          OTHER           (IF OTHER, PLEASE EXPLAIN)
GIVE INFORMATION BELOW ON CURRENT MARITAL STATUS
  DATE OF PRESENT MARRIAGE           PLACE OF MARRIAGE (COUNTRY, STATE, COUNTY AND CITY)
DATE:                                LOCATION:

SPOUSE’S FULL NAME BEFORE MARRIAGE:                        DATE OF BIRTH:               BEST PHONE NUMBER BY WHICH TO BE
                                                                                        REACHED:
SPOUSE’S FORMER ADDRESS:                                   SPOUSE’S PLACE (OR FORMER PLACE) OF EMPLOYMENT:

SPOUSE’S CURRENT JOB TITLE:                                SPOUSE’S WORK PHONE:            SPOUSE’S WORK HOURS:


                       LIST ALL YOUR CHILDREN AND/OR OTHER DEPENDENTS (INCLUDE FOSTER, STEP, ADOPTED):
  FULL NAME OF CHILD               DATE OF BIRTH     BIRTH / LEGAL FATHER AND MOTHER             PRESENT ADDRESS




                    THE FOLLOWING QUESTIONS PERTAIN TO YOU IF YOU HAVE CHILDREN NOT LIVING WITH YOU

DO YOU PAY CHILD SUPPORT?
 NO      YES      IF YES, HOW MUCH?

IS THE CHILD SUPPORT COURT ORDERED? NO       YES

ARE YOUR CHILD SUPPORT PAYMENTS CURRENT?     NO      YES         IF NO, WHY NOT?:

HAVE YOU EVER BEEN DELINQUENT WITH CHILD SUPPORT? NO             YES      IF SO, WHEN AND WHY?

HAVE YOU EVER BEEN TAKEN BACK TO COURT?     NO       YES         IF YES, EXPLAIN:

IF YOU ARE NOT PAYING CHILD SUPPORT, WHAT IS THE FINANCIAL ARRANGEMENT FOR CARE OF THE CHILD?

WHO HAS PRESENT LEGAL CUSTODY OF THE CHILDREN?

WHAT ARE YOUR VISITATION RIGHTS?


                                                            Page 12 of 19
IS YOUR VISITATION SUPERVISED OR UNSUPERVISED?
                                LIST ALL FORMER MARRIAGES (GIVE ALL INFORMATION EVEN IF DECEASED).
FULL NAME BEFORE MARRIAGE                 CURRENT LAST NAME         PRESENT ADDRESS                            DATE OF MARRIAGE

PLACE OF MARRIAGE                               PRESENT PHONE NUMBER                      DATE OF DIVORCE

PLACE OF DIVORCE                                COURT                                     COURT FILE NUMBER


REASON FOR DIVORCE

FULL NAME BEFORE MARRIAGE                 CURRENT LAST NAME         PRESENT ADDRESS                            DATE OF MARRIAGE


PLACE OF MARRIAGE                               PRESENT PHONE NUMBER                      DATE OF DIVORCE

PLACE OF DIVORCE                                COURT                                     COURT FILE NUMBER

REASON FOR DIVORCE

HAVE YOU BEEN INVOLVED IN A DOMESTIC VIOLENCE INCIDENT?        NO       YES      IF YES, PLEASE EXPLAIN:



                       X. FAMILY INFORMATION ~ PARENTS AND SIBLINGS
                             LIST ALL PARENTAL INFORMATION (INCLUDE ADOPTIVE PARENTS IF APPLICABLE)
FATHER’S FULL NAME                               BIRTHDATE                              PLACE OF BIRTH


ADDRESS (STREET, CITY, STATE, ZIP)               HOME PHONE                   PLACE OF EMPLOYMENT AND WORK PHONE


STEP-FATHER’S FULL NAME                          BIRTHDATE                                   PLACE OF BIRTH

ADDRESS (STREET, CITY, STATE, ZIP)               HOME PHONE                   PLACE OF EMPLOYMENT AND WORK PHONE


MOTHER’S CURRENT NAME                         MAIDEN NAME                        BIRTHDATE                 PLACE OF BIRTH

ADDRESS (STREET, CITY STATE, ZIP)

HOME PHONE                           PLACE OF EMPLOYMENTAND WORK PHONE

STEP-MOTHER’S CURRENT NAME                    MAIDEN NAME                        BIRTHDATE                 PLACE OF BIRTH


ADDRESS (STREET, CITY STATE, ZIP)

HOME PHONE                           PLACE OF EMPLOYMENTAND WORK PHONE


                                       LIST ALL SIBLINGS, INCLUDING STEP, HALF, AND ADOPTIVE
1. FULL NAME                                      BIRTHDATE                               RELATIONSHIP (FULL/HALF/STEP/ADOPTIVE)

ADDRESS (STREET, CITY, STATE,ZIP)                HOME PHONE                      PLACE OF EMPLOYMENT AND WORK PHONE


2. FULL NAME                                     BIRTHDATE                                  RELATIONSHIP (FULL/HALF/STEP/ADOPTIVE)

ADDRESS (STREET, CITY, STATE,ZIP)                HOME PHONE                      PLACE OF EMPLOYMENT AND WORK PHONE

3. FULL NAME                                     BIRTHDATE                                  RELATIONSHIP (FULL/HALF/STEP/ADOPTIVE)


ADDRESS (STREET, CITY, STATE,ZIP)                HOME PHONE                      PLACE OF EMPLOYMENT AND WORK PHONE


4. FULL NAME                                     BIRTHDATE                                  RELATIONSHIP (FULL/HALF/STEP/ADOPTIVE)




                                                             Page 13 of 19
ADDRESS (STREET, CITY, STATE,ZIP)                HOME PHONE                     PLACE OF EMPLOYMENT AND WORK PHONE


5. FULL NAME                                      BIRTHDATE                                 RELATIONSHIP (FULL/HALF/STEP/ADOPTIVE)

ADDRESS (STREET, CITY, STATE, ZIP)               HOME PHONE                     PLACE OF EMPLOYMENT AND WORK PHONE

6. FULL NAME                                      BIRTHDATE                                 RELATIONSHIP (FULL/HALF/STEP/ADOPTIVE)

ADDRESS (STREET, CITY, STATE, ZIP)              HOME PHONE                      PLACE OF EMPLOYMENT AND WORK PHONE



                            XI. FAMILY INFORMATION ~ SPOUSE’S FAMILY
                               LIST SPOUSE’S PARENTS, STEP-PARENTS, SIBLINGS, AND STEP-SIBLINGS BELOW.
1. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT:

2. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT:

3. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT:

4. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT AND WORK PHONE:

5. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT AND WORK PHONE:

6. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT AND WORK PHONE:


7. FULL NAME:                                     BIRTHDATE:                                RELATIONSHIP TO SPOUSE:

BEST PHONE NUMBER TO CONTACT THIS PERSON:                                       PLACE OF EMPLOYMENT AND WORK PHONE:


                                                    XII. REFERENCES
LIST FIVE (5) REFERENCES, NOT RELATIVES, WHO HAVE KNOWN YOU FOR AT LEAST THREE (2) YEARS. DO NOT LIST ANY PAST OR PRESENT
EMPLOYERS. NOTE: COMPLETE INFORMATION IS REQUIRED.
1. FULL NAME:                         # OF YEARS KNOWN:      HOME/CELL/WORK PHONES:


HOME ADDRESS (STREET, CITY, STATE, ZIP):               OCCUPATION:                  WORK ADDRESS (STREET, CITY, STATE, ZIP):

2. FULL NAME:                         # OF YEARS KNOWN:           HOME/CELL/WORK PHONES:


HOME ADDRESS (STREET, CITY, STATE, ZIP):               OCCUPATION:                  WORK ADDRESS (STREET, CITY, STATE, ZIP):

3. FULL NAME:                         # OF YEARS KNOWN:           HOME/CELL/WORK PHONES:

HOME ADDRESS (STREET, CITY, STATE, ZIP):               OCCUPATION:                  WORK ADDRESS (STREET, CITY, STATE, ZIP):

4. FULL NAME:                          # OF YEARS KNOWN:               HOME/CELL/WORK PHONES:

HOME ADDRESS (STREET, CITY, STATE, ZIP):               OCCUPATION:                  NAME OF EMPLOYER:




                                                            Page 14 of 19
5. FULL NAME:                          # OF YEARS KNOWN:                   HOME/CELL/WORK PHONES:


HOME ADDRESS (STREET, CITY, STATE, ZIP):                 OCCUPATION:                   NAME OF EMPLOYER:



                                                      XIII. RESIDENCES
WITH WHOM DO YOU PRESENTLY RESIDE? (LIST BELOW):
FULL NAME:                                         BIRTHDATE:                               RELATIONSHIP:

FULL NAME:                                         BIRTHDATE:                               RELATIONSHIP:

FULL NAME:                                         BIRTHDATE:                               RELATIONSHIP:

LIST ALL RESIDENCES WHERE YOU HAVE LIVED (INCLUDING WHILE IN SCHOOL OR MILITARY). BEGIN WITH PRESENT RESIDENCE FIRST. IF
NEEDED, A SUPPLENTAL PAGE IS INCLUDED AT THE END OF THIS PACKET.

FROM:
                       TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO                  STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:
                             :
LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO                  STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:
                             :
LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO                  STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:
                             :
LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:
                       TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                             LANDLORD’S ADDRESS:                                            LANDLORD’S PHONE:


FROM:                  TO:                 STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


                                                                Page 15 of 19
LANDLORD’S NAME:
                                        LANDLORD’S ADDRESS:                                         LANDLORD’S PHONE:


FROM:
                      TO:             STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                        LANDLORD’S ADDRESS:                                         LANDLORD’S PHONE:


FROM:
                      TO:             STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                        LANDLORD’S ADDRESS:                                         LANDLORD’S PHONE:


FROM:
                      TO:             STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                        LANDLORD’S ADDRESS:                                         LANDLORD’S PHONE:


FROM:
                      TO:             STREET ADDRESS: (INCLUDE APT. OR BOX NO.) CITY, STATE, ZIP:


LANDLORD’S NAME:
                                        LANDLORD’S ADDRESS:                                         LANDLORD’S PHONE:


HAVE YOU EVER BEEN EVICTED OR ASKED TO LEAVE A RENTAL HOUSE, APARTMENT OR OTHER DWELLING?
   YES       NO         IF YES, EXPLAIN:
GIVE A BRIEF EXPLANATION OF ANY SERIOUS DISPUTES YOU HAVE HAD WITH FRIENDS, ASSOCIATES, RELATIVES WITH WHICH YOU’VE LIVED, OR
NEIGHBORS. INCLUDE THE NATURE OF THE PROBLEM, THE PEOPLE INVOLVED, THE RESOLUTION AND YOUR ROLE.


                                                  XV. BIOGRAPHY
IN THE SPACE BELOW, IN YOUR OWN WORDS, COMPLETE A SHORT BIOGRAPHY OF YOUR LIFE. IN THIS BIOGRAPHY DESCRIBE THE REASONS YOU
CHOSE TO APPLY WITH THE EL PASO POLICE DEPARTMENT.




                                      XVI. PERSONAL DECLARATIONS
1. IF IT BECOMES NECESSARY TO TAKE A HUMAN LIFE IN THE COURSE OF YOUR DUTIES AS A POLICE OFFICER TO PROTECT YOURSELF, YOUR
PARTNER OR ANOTHER PERSON, WOULD ANYTHING PREVENT YOU FROM DOING SO? YES             NO          IF YES, EXPLAIN:

2. DO YOU HAVE ANY BELIEFS OR ANYTHING ELSE THAT WOULD PREVENT YOU FROM FULLY PERFORMING THE DUTIES OF A POLICE OFFICER,
INCLUDING WORKING ON WEEKENDS, EVENINGS, NIGHT SHIFTS AND/OR HOLIDAYS? YES       NO        IF YES, EXPLAIN:

3. DO YOU KNOW OF ANYTHING OR ARE THEIR ANY INCIDENTS IN YOUR LIFE NOT MENTIONED THAT WOULD DISQUALIFY YOU FROM A POLICE
APPOINTMENT OR PREVENT YOU FROM FULLY DISCHARGING THE OFFICIAL DUTIES OF A POLICE OFFICER? YES      NO
IF YES, EXPLAIN:


                                         XVII. MISCELLANEOUS INFO
                   If you require additional space to answer questions use the following field:




                                                          Page 16 of 19
                                     XVIII. ACKNOWLEDGEMENT
I understand that I should not misstate, omit, minimize or rationalize facts when completing my Comprehensive
Background Investigation Statement. The statements made herein are subject to verification in determining my
qualifications for employment. No statement contained herein shall constitute an offer or condition of employment.

 I understand that the Academy represents a period of selection for the El Paso Police Department and I must complete the
course successfully to become a commissioned police officer. I understand that I may be discharged from the Academy at
any time. I understand that the El Paso Police Academy training will last approximately 25 weeks. I agree that I must also
submit myself to strict police discipline. I further understand that I may not have any other employment or attend any
other school while a recruit in the El Paso Police Academy. I have read and understand the above statement.

I have reviewed this completed Comprehensive Background Investigation Statement and I believe it to be true and correct
to the best of my knowledge and recollection. I understand that AFTER I have submitted this Comprehensive
Background Investigation Statement, I MUST inform the Background Investigation Unit, IMMEDIATELY, of
any changes or updated information contained in this statement. All changes or updated information MUST be
made both orally and in writing within seven (7) days of the date of any change. Failure to do so could be basis
for rejection of my employment with the El Paso Police Department. All information obtained during the
investigation will be used as a basis of questioning during the Chief Selection Board.




        Print name                                        Signature                                 Date




Subscribed and sworn to before me this ________ day of                             .




                                                                                        Notary Public
                                                       My commission Expires




                                                      Page 17 of 19
                                          El Paso Police Department ♦ Human Resources Division
                                                    911 N. Raynor ♦ El Paso, TX 79903
                                                       915-564-6958 ♦ www.eppd.org


                        WAIVER AND AUTHORIZATION FOR RELEASE OF INFORMATION
To Whom It May Concern:

I authorize you to furnish any El Paso Police Department (EPPD) background investigator, or other duly accredited representative
of the EPPD conducting my background investigation, any information relating to my activities from individuals, schools,
residential management agents, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection
agencies, retail business establishments, or other source of information. This information may include, but is not limited to, my
academic, residential, achievement, performance, attendance, disciplinary, employment history, criminal history record
information, financial and credit information, and military service records, or any background investigation information that was
obtained as a result of my application for employment. Information of a confidential or privileged nature may be included. Your
reply will be used to assist the police department in determining my qualifications and fitness for the position I am seeking with
the Department. This includes individuals identified by the EPPD representative, who might have information about my suitability
for employment.

I further authorize you to release arrests, detentions, field citations, field interview cards, officer’s records, jail/custody booking
records, traffic citations and traffic accident information, district attorney records, court records and reports, probation and parole
reports and records, laboratory reports and results, and any other criminal justice records, reports, or information source. This
inquiry is in compliance with the applicable state code and local ordinances.

I have read and understand my rights under Title 5, United States Code, Section 552A, the Privacy Act of 1994, and waive those
rights with the understanding that information furnished will be used by the El Paso Police Department in conjunction with
employment procedures. I understand that information obtained by the El Paso Police Department may be made accessible to
other law enforcement agencies if a proper waiver is provided. I understand that I am waiving any right I may have to this
information and it will not be released to me or any private citizen under any circumstance. If however, the El Paso Police
Department discovers that I am involved in any felonies, the Department is obligated by law, to report this information to the
proper jurisdiction. This waiver and release applies to information covered by Title 5 as well as information not covered by that
statute.

I hereby release the El Paso Police Department, you, your organization, and your office’s agents and employees, and others from
any liability or damage which may result from furnishing the information requested, including any liability pursuant to any state or
local code or ordinance, or any similar laws.

COPIES OF THIS AUTHORIZATION THAT SHOW MY SIGNITURE ARE AS VALID AS THE ORIGINAL
RELEASE SIGNED BY ME. THIS AUTHORIZATION IS VALID FOR TWO (2) YEARS FROM THE DATE SIGNED
OR UPON TERMINATION OF MY AFFILIATION WITH EPPD.

_________________________________________________________________________________________________________
Signature (Sign in ink)      Full Name (Type or Print Legibly)   Date of Birth         Social Security #

_________________________________________________________________________________________________________
Other Names Used                                                        Date signed


SUBSCRIBED AND SWORN TO BEFORE ME ON THE ________ Day of ____________, __________.


                                                                                   ____________________________________

                                          NOTARY PUBLIC STATE OF: ______________________________________



                                                            Page 18 of 19
                                               El Paso Police Department ♦ Human Resources Division
                                                         911 N. Raynor ♦ El Paso, TX 79903
                                                            915-564-6958 ♦ www.eppd.org



                        WAIVER AND AUTHORIZATION FOR RELEASE OF INFORMATION
To Whom It May Concern:

I authorize you to furnish any El Paso Police Department (EPPD) background investigator, or other duly accredited representative
of the EPPD conducting my background investigation, any information relating to my activities from individuals, schools,
residential management agents, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection
agencies, retail business establishments, or other source of information. This information may include, but is not limited to, my
academic, residential, achievement, performance, attendance, disciplinary, employment history, criminal history record
information, financial and credit information, and military service records, or any background investigation information that was
obtained as a result of my application for employment. Information of a confidential or privileged nature may be included. Your
reply will be used to assist the police department in determining my qualifications and fitness for the position I am seeking with
the Department. This includes individuals identified by the EPPD representative, who might have information about my suitability
for employment.

I further authorize you to release arrests, detentions, field citations, field interview cards, officer’s records, jail/custody booking
records, traffic citations and traffic accident information, district attorney records, court records and reports, probation and parole
reports and records, laboratory reports and results, and any other criminal justice records, reports, or information source. This
inquiry is in compliance with the applicable state code and local ordinances.

I have read and understand my rights under Title 5, United States Code, Section 552A, the Privacy Act of 1994, and waive those
rights with the understanding that information furnished will be used by the El Paso Police Department in conjunction with
employment procedures. I understand that information obtained by the El Paso Police Department may be made accessible to
other law enforcement agencies if a proper waiver is provided. I understand that I am waiving any right I may have to this
information and it will not be released to me or any private citizen under any circumstance. If however, the El Paso Police
Department discovers that I am involved in any felonies, the Department is obligated by law, to report this information to the
proper jurisdiction. This waiver and release applies to information covered by Title 5 as well as information not covered by that
statute.

I hereby release the El Paso Police Department, you, your organization, and your office’s agents and employees, and others from
any liability or damage which may result from furnishing the information requested, including any liability pursuant to any state or
local code or ordinance, or any similar laws.

COPIES OF THIS AUTHORIZATION THAT SHOW MY SIGNITURE ARE AS VALID AS THE ORIGINAL
RELEASE SIGNED BY ME. THIS AUTHORIZATION IS VALID FOR TWO (2) YEARS FROM THE DATE SIGNED
OR UPON TERMINATION OF MY AFFILIATION WITH EPPD.

_________________________________________________________________________________________________________
Signature (Sign in ink)      Full Name (Type or Print Legibly)   Date of Birth         Social Security #

_________________________________________________________________________________________________________
Other Names Used                                                        Date signed


SUBSCRIBED AND SWORN TO BEFORE ME ON THE ________ Day of ____________, __________.


                                                                                   ____________________________________

                                          NOTARY PUBLIC STATE OF: ______________________________________



                                                            Page 19 of 19

								
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